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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 325 -329. doi: 10.3877/cma.j.issn.1674-3253.2021.04.013

临床研究

二次电切术在T2期膀胱癌保留膀胱综合治疗中的临床意义
陈令秋1, 王鹏1, 袁龙平1, 乙从亮1,†()   
  1. 1. 235000　安徽，淮北市人民医院泌尿外科
  • 收稿日期:2020-12-16 出版日期:2021-08-01
  • 通信作者: 乙从亮
  • 基金资助:
    淮北市科技计划(rj201809)

Significance of second transurethral resection in stage T2 bladder carcinoma patients treated with bladder-preserving therapy

Lingqiu Chen1, Peng Wang1, Longping Yuan1, Congliang Yi1,†()   

  1. 1. Department of Urology, People’s Hospital of HuaiBei City, An Hui 23500, China
  • Received:2020-12-16 Published:2021-08-01
  • Corresponding author: Congliang Yi
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陈令秋, 王鹏, 袁龙平, 乙从亮. 二次电切术在T2期膀胱癌保留膀胱综合治疗中的临床意义[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 325-329.

Lingqiu Chen, Peng Wang, Longping Yuan, Congliang Yi. Significance of second transurethral resection in stage T2 bladder carcinoma patients treated with bladder-preserving therapy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 325-329.

目的

初步探讨二次电切术在T2期膀胱癌保留膀胱综合治疗（BPT）中的临床意义。

方法

回顾性分析2013年6月至2020年6月淮北市人民医院收治的71例不能耐受或拒绝行膀胱肿瘤根治性切除术的T2期膀胱癌患者，根据手术方式将其分为两组，33例患者首次电切术后4～6周行二次电切术，38例患者仅行单次电切术。术后所有患者均接受吉西他滨+顺铂（GC）化疗方案及膀胱灌注药物治疗，并进行长期随访。结合患者随访资料分析二次电切术与无疾病生存期（DFS）的关系。

结果

两组患者在手术时间、住院日、术中出血量及术后并发症方面差异无统计学意义。Kaplan-Meier生存曲线显示，二次电切组DFS为60.6个月，显著高于单次电切组47.2个月，两组差异有统计学意义（P=0.009）。Cox多因素比例模型分析显示，是否行二次电切术是肿瘤复发、进展的影响因素（HR值=0.172，95%CI 0.039-0.761，P<0.05）。

结论

与单次膀胱肿瘤电切相比，二次电切术可能有助于降低T2期膀胱癌患者BPT术后复发和进展的风险，有望为T2期膀胱癌保留膀胱综合治疗提供新的选择。

关键词: 膀胱癌, 综合治疗, 膀胱切除术, 无疾病生存期
Objective

To investigate the clinical significance and safety of second transurethral resection for patients with stage T2 bladder carcinoma treated with bladder-preservation-therapy(BPT) protocal.

Methods

The clinical data of 71 patients with stage T2 muscle-invasive bladder carcinoma treated with BPT in People’s Hospital of Huaibei city between June 2013 and June 2020 were analyzed retrospectively. The patients were evaluated by CT/MRI and confirmed as stage T2 bladder carcinoma by biospy after surgery. All of them were medically unfit or refused radical surgery. Among them, 33 patients underwent secondary transurethral resection of bladder cancer (TURBT) after initial resetion, the others didn't underwent secondary TURBT. After TURBT with or without secondary TURBT, patients received chemotherapy of gemcitabine plus cisplatin (GC) and bladder perfusion according to oncologist’s consultion. The relationship of secondary TURBT and disease-free survival (DFS) was analyzed to illustrate the clinical value of secondary TURBT in BPT protocal of stage T2 bladder carcinoma.

Results

There was no significant difference in operation time, hospitalization days, blood loss or postoperative complications between two groups. Kaplan-Meier analysis showed that the mean DFS of secondary TURBT group was 60.6 months, while the other group was 47.2 months. The differences were statistically significant.Cox proportion-hazards regression modal analysis incidated that the secondary TURBT was an independent prognostic factor for stage T2 bladder carcinoma.

Conclusion

Secondary TURBT might alleviate the incidence of recurrence and progression of stage T2 bladder carcinoma patients underwent BPT protocal, compared to single TURBT, which can provide an effective and safe treatment option for patients.

Key words: Bladder carcinoma, Therapy protocal, Bladder resection, Disease-free survival
表1 两组T2期膀胱癌患者基本资料比较
组别 例数 性别(例) 年龄[岁，M(Q)] 肿瘤直径[cm，M(Q)] 肿瘤数目(例) 肿瘤病理分级(例)
男 女 单发 多发 低级别 高级别
二次电切组 33 28 5 78(88,43) 3.0(4.0,1.0) 21 12 13 20
单次电切组 38 25 13 74(86,22) 2.5(5.2,1.0) 20 18 18 20
统计值   χ2=3.39 Z=-0.104 Z=-0.317 χ2=8.77 χ2=1.85
P值   0.066 0.917 0.752 0.349 0.174
组别 手术时间[min，M(Q)] 术后血红蛋白下降值[g/L，(±s)] 住院天数[d，(±s)] 术后血尿(例) 术后感染(例) 复发(例)
有 无 有 无 是 否
二次电切组 50(15,150) 12.3±2.3 12.4±4.4 2 31 4 29 2 31
单次电切组 42.5(10,115) 8.9±0.8 11.4±2.7 1 37 3 35 14 24
统计值 Z=0.59 t=1.40 t=1.09 - - - - 9.586
P值 0.550 0.158 0.279 0.594 0.697 0.002
图1 两组患者生存曲线比较
表2 COX风险比例回归模型分析结果
变量 多因素分析
Wald P值 Exp(B) 95%CI
年龄 0.104 0.747 1.008 0.958～1.061
性别 0.993 0.319 1.748 0.583～5.245
病理分期(高/低级别) 0.732 0.395 0.607 0.192～1.917
肿瘤数量(多/单发) 0.235 0.628 1.460 0.316～6.745
肿瘤直径(>3cm/≤3 cm) 1.043 0.307 1.846 0.569～5.985
电切(二次/单次) 5.893 0.015 0.033 0.695
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